During a martial art class, many of us have seen a student stopping to use an inhaler. Asthma is primarily a childhood disease that affects 3-5 percent of the American population. Fifty percent of these asthmatics begin having symptoms during childhood and, of those, half will no longer have the disease by young adulthood. So chances are that there will be at least one asthmatic in your martial art class. Asthma is characterized by recurrent spasm of the airways induced by certain "triggers" or stimuli, such as allergens (such as molds, animal dander, and pollen), cold, emotional stress, respiratory infections, irritants (such as smoke, perfume, or dust), and, of major concern to us, exercise. Airway sensitivity to these triggers causes acute episodes of asthmatic symptoms in susceptible persons. Persons with long-term or chronic asthma also suffer from chronic airway inflammation.
Symptoms of asthma include cough, chest tightness, shortness of breath, and wheezing. Wheezing occurs because of acute airway spasm, which decreases the opening of the airway resulting in less air entering the lungs. As the wheezing worsens, inflammatory cells enter the lining of the airways and cause swelling and mucous production, which leads to increasing shortness of breath, chest tightness, and cough. Of the many stimuli that trigger an asthma attack, Taekwondo students are most concerned with exercise. Most asthmatics suffer from exercise-induced asthma, but there are some individuals who suffer symptoms only during exercise.
Symptoms of exercised-induced asthma are similar to general asthma and usually occur with moderate to intense exercise. Cooling and drying of the airway, which occurs with an increase rate of breathing, is thought to cause an exercise-induced asthma attack. During normal breathing while at rest, we breathe through our noses. Our noses moisten, warm, and filter the air that we breathe. As we exercise, our breathing rate increases and we open our mouths to get more air into the lungs. Breathing through the mouth bypasses the nose so that dry, cool air is taken into the lungs.
Typically, those with exercise-induced asthma start wheezing 10-20 minutes after they stop exercising and the wheezing usually will stop after 60-90 minutes without treatment. However, symptoms may spontaneously return 4-6 hours after the initial exercise. This reoccurrence may be of concern to Taekwondo students who attend a camp or a tournament where they may need to exert themselves 4-6 hours after an initial physical exertion. Athletes in sports requiring short bursts of energy are generally less affected by exercise-induced asthma than those competing in sports with longer energy requirements, such as long distance running, so Taekwondo athletes may be less susceptible than long distance runners but there are individual variations.
Treatment of exercise-induced asthma focuses on prevention of symptoms through proper conditioning and warm up and use of medications to open the airways. Prior to training, those afflicted with exercise-induced asthma should warm up at least 5 minutes in a high humidity environment, such as in an indoor pool, whirlpool, hot tub, or sauna. Although this is most effective means of prevention, it may not be the most practical. Asthma sufferers should strive to nose breath as much as possible during training and competition. Proper physical training improves endurance, reduces the need to breathe through the mouth, and decreases symptoms of exercise-induced asthma.
The use of certain medications, such as Albuterol (Ventolin, Proventil) inhalers, has been shown to be 90% effective in preventing symptoms of exercise-induced asthma. The recommended regimen is 2 puffs 10-15 minutes prior to competition. Albuterol produces rapid results and lasts up to 4-6 hours. Those with chronic asthma may benefit from inhaled steroids taken on a regular basis in addition to the use of albuterol inhalers prior to exercise. Other medications shown to be of benefit to chronic asthmatics include cromolyn sodium (Intal) and the new leukotriene inhibitors (Accolate). These medications are effective when taken regularly as a preventive measure.
Many of the prescribed asthma medications are powerful stimulants and some have anabolic properties. Therefore, the International Olympic Committee (IOC) prohibits the use of certain forms of these medications during competition. Oral or injectable forms of beta-2 agonists (Albuterol) are strictly prohibited. Albuterol inhalers are permitted, but require written notification from the athlete's physician. For a complete list of banned substances refer to the IOC's or the USOC's websites.
For some information on how the martial arts have helped asthma sufferers, check out these links submitted by Master Nottingham:
http://johnnottingham.com/asthma.pdf [Article reprinted with permission]
McKee, K. D.O. Family Practice Resident. 2nd Degree Black Belt. Asthma in the Taekwondo Athlete.